Placebo Effect Explained

Ben Goldacre just tweeted this great video commissioned by the NHS of him explaining the placebo effect in layman’s terms. Not aimed at me, but absolutely perfect for, say, my mum, I’m going to find a lot of use for this video. Nice one Ben (and the NHS).

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The video is brilliant, especially the point he makes about how to use the placebo effect. This is something I’ve seen relatives of mine struggle to get across to their med students. People have bought this idea that medicine is supposed to be like ‘House’, that the exams and procedures are the only thing that matters and how you relate to the patient is secondary or even irrelevant. Many doctors don’t seem to think that the skills they’ve developed to improve the way they relate to the patient and to really hear what they have to say are real medicine – and, unfortunately, that’s where the alternative medicine quacks gain ground.

Briarking- I just did this accidentally for my neighbor’s dog. He seemed to have a sharp pain in his shoulder for a few days so even though I know nothing about medical science, I did grow up on a farm. So I VERY carefully and slowly tried to find the exact spot that hurt, looking for some mark on his skin, etc. He hadn’t let anyone else touch him but after about 30 minutes of combing his fur and prodding and praising and not finding anything, I gave him a little treat and played on the floor with him. When the neighbor had him at home for a few hours she asked if I had done some kind of ‘healing’ (I live in a very woo town). He wasn’t sensitive there anymore and she could pet him there now.
What I think happened was that something very painful had happened and now he was being overly cautious about that spot so he didn’t get that pain again. When I spent a lot of time showing him it didn’t hurt anymore, he ‘suddenly’ got better. I also acted like he was healthy and could play without pain.

Showed this to some of my students. We are studying human body systems with an emphasis on medicine.They asked me if there are any studies done where participants took the placebo for part of it and then were given the real treatment (presumably at a randomly assigned time). If so, what study? If not, why not? I don’t know the answer. Do any of you?

^ Isn’t that what’s usually done at the end of a vaccine study? I’m pretty sure the placebo group of the Merck HPV vaccine study was given the actual treatment once the data was unblinded and efficacy was proven.

In other news, Dr. Goldacre is so awesome, I want to have like 10,000 of his babies.

It brings up what may be a misconception I have on what a placebo can do. He says that it can reduce gastric ulcers where I think a placebo’s effect was limited to subjective symptoms like pain and comfort.

Sugar ingested causes the body to move large amounts of salt (from blood) into the intestines. It may well have effects in the stomach, I’m not sure. In other words, when you eat stuff, your eating-bits do stuff. Therefore, I am not suprised that the “placebo” effect is strongest with sugar pills when applied to eating-bits ailments, and I am not surprised that more “placebo” (sugar) does more.

Putting this another way, when it comes to the digestive track, sugar is not inert!!!! Not even close!!!!!

And this does suggest a major reason why many “alternative” treatments like reiki and color therapy seem to work. On average those practitioners spend a lot more time with patients than doctors and nurses, often see them much more often, and because they make a higher profit, they can afford nicely decorated offices.

And I also think there might be another principle at play. Studies have shown that when people pay for something themselves, they show greater satisfaction in it than when it’s free – and the more they pay, the higher quality they’ll usually consider it. So the free injection from a physician who spends five minutes with you doesn’t seem as “valuable” as the $100 you spent for a half hour with the chiropractor poking you in a friendly manner.